HHS Officials Explain $47.9B in Improper Medicare Payments
Overall, Medicare paid $516 billion in 2010 for medical services for 47 million Americans, according to government estimates.
Michelle Snyder, deputy COO at the Centers for Medicare & Medicaid Services, told the subcommittee that "like other large and complex Federal programs, Medicare is susceptible to payment, billing, and coding errors."
"It is important to clarify what these billing anomalies are – and are not," she said in prepared remarks.
Snyder said circumstances that lead to billing and coding errors can result from:
- Services with insufficient documentation,
- Provided services that are not determined to bereasonable and necessary
- Incorrectly coded claims
- Services with no documentation
"Further, improper payments do not mean an item or service was not needed. These payments are not necessarily fraudulent; rather, they tend to be an indication of errors made by the provider in filing a claim or inappropriately billing for a service," Snyder told the committee.
Kay L. Daly, director of Financial Management and Assurance at the Government Accountability Office told the subcommittee that the estimate for improper payments was "incomplete" because it has yet to provide an improper payment estimate for Medicare prescription drug payments, which totaled $59 billion in fiscal year 2010.
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